Archive for the ‘Anti Depressants-Sleeping Aid’ Category

If convinced that a spiritual dimension may be touched by both alcoholism and recovery, what do you as a counselor do? First, we recommend cultivating some members of the clergy in your area. It seems that many communities have at least one member of the clergy who has stumbled into the alcohol field— and we do mean stumbled. It was not a deliberate, intellectual decision. It may have occurred through a troubled parishioner who has gotten well, or one whom the clergy member couldn’t tolerate watching drink himself to death any longer and so blundered through an intervention. The pastor may have aided some alcoholics and finds more and more showing up on his doorstep for help. This is the one you want. If you cannot find him, find one with whom you are comfortable talking about spiritual or religious issues. That means one with whom you don’t feel silly or awkward and, equally important, who doesn’t squirm in his seat either at talk of spiritual issues. (Mention of God and religion can make people, including some clergy, as uncomfortable as talk of drinking can!)Once you find a resource person, it is an easy matter to provide your client with an opportunity to talk with that person. One way to make the contact is simply to suggest that the client sit down and talk with Joe Smith, who happens to be a Catholic priest, or a Jewish rabbi, or something else. It may also be worth pointing out to the client that the topic of concern is important and that the individual mentioned may be helpful in sorting it out. Set up the appointment and let the clergy member take it from there. Some residential programs include a clergy member as a resource person. This person may simply be available to counsel with clients or may take part in the formal program, for example, by providing a lecture in the educational series. What is important is that the presence and availability of this person gives the message to clients that matters of the spirit are indeed important and not silly.How do you recognize the person for whom spiritual counseling may be useful? First, let us assume you have found a clergy member who doesn’t wag a finger, deliver hellfire and brimstone lectures, or pass out religious tracts at the drop of a hat. Rather, you have found a warm, caring, accepting, and supportive individual. A chat with someone like that isn’t going to hurt anyone. So don’t worry about inappropriate referrals. Nonetheless, for some clients the contact may be particularly meaningful. Among these are individuals who have a spiritual or religious background and are not experiencing it as a source of support, but rather as a condemnation. Others may, in their course of sobriety, be conscientiously attempting to work the AA program, but have some problem that is hanging them up. Another group who may experience difficulty are Jewish alcoholics. “Everyone knows Jews don’t become alcoholics.” This presents a problem for those who do. It has been said that there is double the amount of denial and consequent guilt for them. Because the Jewish religion is practiced within the context of a community, there may also be a doubled sense of estrangement. A contact with a rabbi may be very important. It is worth pointing out that someone can be culturally or ethnically Jewish, but not have been religiously Jewish. The intrusion of an alcohol problem may well provide the push to the Jewish alcoholic to explore his spiritual heritage. The alcohol counselor is advised to be sensitive to this as well as supportive.The counselor, as an individual, may or may not consider spiritual issues personally important. What the caregiver needs is an awareness of the possibility (even probability) of this dimension’s importance to a client, as well as a willingness to provide the client with a referral to an appropriate individual.*139\331\2*

The basic concept is that there are three stages in stress breakdown, each stage with its characteristic symptoms.
The symptom of the first stage – anxiety.
The two extra symptoms of stage two are loss of emotional control, and loss of self-motivation.
The three major symptoms of stage three are intolerance of sensory stimulation, inability to tolerate things previously tolerated and apparent change in priorities and attitudes.
You may find that you suffer from some of these symptoms some of the time, or perhaps all of them some of the time or some of them all of the time. People vary quite a lot in how often they slip in and out of these stages I have described when they are experiencing stress breakdown.
What to do about your stress breakdown symptoms? The quick answer is always rest, relief of stress and a lot more sleep. There are other things to consider, such as eating properly and avoiding alcohol and stimulants.
Let us look at what practical steps we might take when experiencing significant stress, to prevent stress breakdown. We will look first at the situation where a person is beginning to experience anxiety symptoms while under stress.

Symptom check-list
Firstly, we must make sure that what you’re suffering from is in fact anxiety. Let’s check the symptoms out. Do you experience any of these symptoms?
1. A vague but urgent feeling of unease or dread, as though you are expecting something to go wrong, but you don’t know what it is.
2. A feeling of being ‘wound up’, ‘up-tight’, ‘tense’ and of feeling jumpy, more easily startled, for example if the telephone rings unexpectedly.
3. Are you having a little bit of difficulty unwinding get off to sleep easily at night?
4. Do you suffer from three or more of the following symptoms?
Palpitations or rapid pulse rate.
Headaches.
Lower backache.
Feelings of heaviness in the chest.
Sharp chest pains, coming from sore spots on the chest wall.
Discomfort in the upper part of the abdomen.
Increased frequency of passing urine.
Tremor or shakes of the hands.
Sweaty palms of the hands.
Stiffness of back and shoulder muscles.
Over-breathing and feelings of panic from time to time.
If you answered ‘yes’ to the first three questions, and ‘yes’ to three or more of the symptoms in question four, then you have most probably been suffering from symptoms of anxiety, which is the alarm signal that lets you know that your nervous system is having difficulty coping with the tasks it has been set.
However, you could possibly be suffering instead from some medical illness, the symptoms of which resemble anxiety, such as those of low blood calcium, or some medical disorder which causes increased release of adrenaline and therefore produces some of the body symptoms of anxiety itself.

Whereas the psychosomatic symptoms of stage one have predictability about them, the psychosomatic symptoms of stage three are unpredictable. The symptoms of stage one, either symbolic symptoms or symptoms resulting from a predictable response to anxiety, are produced by the normal functioning of the body’s warning mechanisms and by normal patterns of adaptation to the anxiety response.
However, the psychosomatic symptoms of stage three are due to malfunction of conditioned reflexes and the symbolic symptoms of stage three are due to malfunction of the brain’s self-protecting mechanisms.
Because the psychosomatic symptoms of stage three arise as the result of malfunction of conditioned reflexes, the body’s functions may be seriously hampered, and the person in stage three stress breakdown can become seriously ill.
Let us look at stage three symptoms in these two categories.
1. Symptoms due to malfunction of conditioned reflexes.
2. Symptoms due to conversion.

Another possible explanation of why we sleep is the chemical theory. We are all aware of the fact that certain chemical substances induce sleep; we have all heard of sleeping pills. When we take a sleeping pill, the drug is absorbed into the blood and acts on the brain. The drug induces sleep. When the drug wears off and is eliminated from the body, we wake up.

Is there a sleep-inducing, naturally occurring chemical in the body? Also, does this chemical accumulate in the day like a waste product from our metabolism and require elimination? When the chemical reaches a certain threshold, does the brain become drugged and cause us to fall asleep? Whilst asleep, is this chemical eliminated from the body, causing us to wake up refreshed? A French scientist in 1913 called this hypothetical chemical sleep poison or hypnotoxin.

This is shown in the example of Siamese twins. Siamese twins are two twins born together with some parts of their bodies attached. They share the same blood circulation. It is observed that one twin can be wide awake whilst the other is fast asleep. If there is a chemical in the blood causing sleep, then the two twins should be waking and sleeping at the same time. This clearly demonstrates that ‘natural sleep’ is not due to a chemical or a drug circulating in the blood. On the other hand, if one twin is given an appropriate dose of sleeping pill, after this is absorbed into the blood the two twins sleep at the same time. This shows that sleep induced by sleeping pills is very different from natural sleep, and the chemical theory is unable to explain why we need to sleep.

However, in spite of this, there is still considerable research taking place to examine the possibility of the presence of hypnotoxin. Claims were made that extracts of spinal fluid from sleep-deprived animals when injected into waking animals would induce sleep. US scientists called this substance in the spinal fluid factor S (S for sleep) and Japanese scientists called it sleep-promoting substance or SPS. Sleep-deprived animals were used for the source of this substance as it was believed that factor S or SPS accumulated greatly in these animals, since only sleep could eliminate it.

Some people make the various steps in sexual knowledge and experience from childhood to maturity much more easily than do others. In this respect the shy introvert typically has greater difficulties that his more robust extrovert contemporaries. The introvert, either boy or girl, is inclined to be timid and embarrassed by matters of sex. As a result he withdraws from it. His knowledge is incomplete, and his emotional and physical contacts with the other sex are limited. He tends to fill in the gaps in his knowledge by daydreaming. His uncertainties and perplexities are increased, and the general level of his anxiety remains high. Strange as it may seem, such a pattern established in adolescence may later persist through marriage.

In an attempt to put an end to his complicated feeling in the matter, the shy introvert not infrequently decides to have a sexual experience. This usually lacks any spontaneous naturalness, and is often preceded by much thought and determination to bring himself to do it. The whole matter is out of character with his general personality, and instead of making things better the experience almost always has the reverse effect. The tension which accompanies it makes it physically difficult, and the sensitivity of the introvert adds guilt to his anxiety. Experience in psychotherapy with young people shows quite clearly that the inhibited introvert of either sex is greatly helped by talking over these matters with an experienced physician or psychiatrist.

I recently had come to me a young woman who was very shy—very nice, attractive in her quiet way, well-mannered, but painfully shy. Her parents, successful and easy in company, were socially ambitious for the girl. But she was held back; she just could not be natural with people. Then with tears and great distress she told me how a boy had touched her sexually, but really quite innocently. “I can never forgive myself.” Then when she had pulled herself together, “How do you know where to draw the line?”

This is a problem that we all must face. She is twenty, but so timid and shy that she draws the line too high. And in her present state this must necessarily be so. We must not forget that different people need different solutions to similar problems according to their individual personality.

The 1996 German list of available drugs, the Rote Liste, includes 28 Hypericum preparations. Since these preparations are not chemically defined single-substances or combination preparations, but whole extracts of the St John’s Wort plant, it cannot automatically be assumed that the various medicinal preparations from various manufacturers have the same composition and therefore the same therapeutic efficacy at the same dosage.

I agree with Professor Hippius. In other words, since we do not know which substances in St John’s Wort are responsible for its anti-depressant effects, we cannot assume that all plant preparations are equivalent, even if the amount of hypericin, which is supposedly standardized across different preparations, is the same. I say ‘supposedly’ based on my experience with the use of certain generic anti-depressants. Generic anti-depressants are supposed to have the same amount and quality of the active compound in them as the original brand-name products. Yet I have often observed a relapse of depressive symptoms in patients who have previously been doing very well when they switch from a certain brand-name anti-depressant to its generic counterpart. If different brands of a synthetic compound produced under the supervision of the US Food and Drug Administration result in different clinical effects, how much more reason do we have to doubt the equivalency of different herbal products with their complex combinations of active substances and produced under much looser regulatory conditions? Consider, for example, how wines that are made from the same type of grape will vary in taste not only from one country or region to another but even from vintage to vintage. The substances in the wine that imbue it with its special bouquet and flavour will change with the soil, the amount of sunshine and the rainfall. A similar situation can be expected to apply to the composition of an extract of St John’s Wort, where the variable of interest is not the flavour but rather the anti-depressant effects or the side-effects of the preparation.

Once we acknowledge that herbal preparations are likely to vary in their composition, where does that leave us in terms of choosing the best preparation? Yet most of the research in which the anti-depressant effects of St John’s Wort have been established has been performed using the brand called Jarsin™ produced by the leading German manufacturer of the herbal remedy. This has led clinician and researcher Hans-Peter Volz of Jena in Germany to conclude that ‘taken in sum, the anti-depressive action of Hypericum is only sufficiently documented for Jarsin™.’

The good news is that Jarsin™ is now available over the counter under the brand name of Kira™. It is essentially identical to the German compound and is clearly the brand of choice at this time.

Another reason to use an herbal product known to be made under carefully supervised conditions is that you can feel more confident that there are no potentially toxic contaminants in the preparations, such as have been known to occur in other food supplements. The contaminant in L-tryptophan that resulted in several fatalities in the US was a particularly dramatic case in point.

Some local brands of St John’s Wort are less expensive than Kira™ and for certain individuals the cost difference may be a significant consideration. If this is the case, I would suggest at least starting with the Kira™ brand. If your depression does not respond, you can then be more confident that it is not because of the brand of the herbal remedy but for other reasons. Once your depression does respond to Kira™, if cost is a significant consideration you might then try to switch to a less expensive brand and see if you maintain the same level of anti-depressant response.

Cognitive therapy is a short-term structured form of psychotherapy based on the idea that the way a patient perceives the world determines behavior. The tendency to see oneself, the world about one, and the future in a negative way often leads to depression, according to this school of thought. Treatment is aimed at altering these cognitive misperceptions by helping patients gather evidence to counteract this distorted view.

Behavioral therapy is a form of psychotherapy that aims to inhibit or extinguish “learned” neurotic responses. Techniques include assertiveness training, biofeedback, aversive therapy, conditioning, contract therapy, flooding, and desensitization. There are a limited number of reports that certain illnesses responsive to Prozac, including OCD and phobias, are more effectively treated with the combination of behavioral therapy and Prozac or older antidepressants man with medication alone.

Interpersonal Psychotherapy (IPT) is a three-part, time-limited therapy specifically designed to help alleviate major depression. During the first one to three sessions, the psychotherapist takes a psychiatric history and an .interpersonal inventory that focuses on the patient’s psychosocial problems. The middle phase of IPT focuses on the problems of the present (rather than the past) through a series of strategies designed to help the patient cope with grief, interpersonal conflicts, role transitions, and inadequate social skills. During the final phase, the therapist helps the patient learn to recognize and cope with symptoms of depression that might appear in the future.

Various studies have shown that IPT is an effective therapy for some forms of depression even without drugs. This is important because there are many instances in which depressed patients cannot take drugs. Some people are simply not responsive to drugs, some experience uncomfortable or even dangerous side effects, and some have other medical conditions that make taking the drug problematic (pregnancy might be one such condition). However, the best results, especially during the acute phase of major depression, came from the combination of cognitive therapy or IPT with an antidepressant medication.

In no way is Prozac a substitute for lithium. Prozac is an antidepressant, and lithium is a mood stabilizer. Prozac has potent properties of relieving mild to major depression and perhaps prevents recurrent depression as well. At the same time, Prozac may induce mania or hypomania in patients who nave a bipolar manic depressive history but are not taking lithium.

Lithium, on the other hand, has a mild antidepressant effect in depressive disorders, a strong antimanic effect, and, finally, a prophylactic effect on both the highs and lows of bipolar illness and the lows of recurrent depression.

Although lithium is most successful in controlling manic highs, it does not always eradicate the depressive phases of bipolar disorders.

Has Prozac proven to be as effective long-term as lithium? Not yet Lithium, which offered the first effective, long-term treatment for manic depression, has been readily available in the United States since 1973 and was used as early as 1948 in Australia, 1954 in Denmark, and a few years later in England and Canada. Prozac was introduced to the American market in 1987. Consequently, lithium has been clinically evaluated for a much longer time in many more centers and studies around the world. Its uses are known. In many ways, Prozac is still being explored. Are there any long-term complications associated with Prozac or with the combination of Prozac and lithium? No long-term complications of Prozac are to date, although the full story is not in, since Prozac has only been on the market approximately seven years. Only after twenty or thirty years of closely observing a large number of patients taking an antidepressant can one make conclusions about any of its potential long-term complications.

Long-term effects of lithium have been identified, however. They include the possibility of goiter or altered thyroid function in a small percentage of patients. Some long-term lithium patients with previous kidney impairment tend to lose an even greater degree of kidney function over time. These patients should either switch to a lithium alternative such as Tegretol or Depakote, or be maintained on smaller doses of long-term lithium.

This is an important question, because depression hits the elderly hard. Depression is four times more common among the elderly than in the general population and the suicide rate for people over 65 is fifteen times greater than that of the overall population.

Open studies and double blind studies indicate that Prozac relieves the symptoms of depression just as well as other antidepressants in geriatric r patients. Certainly, mild doses of nortriptyline (Aventyl or Pamelor) have been successful in elderly depressed patients in the opinion of many psychiatrists, and other psychiatrists may swear by any number of the older drugs as highly effective. However, patients taking Prozac complained less frequently of dry mouth and constipation, which are typically reported with other antidepressant drugs, and they were much less likely to drop out of the study due to adverse effects. Prozac also lacks adverse cardiovascular effects, compared to the tricyclic antidepressants, and is much less dangerous when taken in overdose. In the opinion of most psychopharmacologic experts, Prozac or one of the other SSRIs is the preferred antidepressant in the elderly.